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Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database.
[heparin-induced thrombocytopenia]
Parenteral
direct
thrombin
inhibitors
(
DTIs
)
may
be
used
in
pediatric
patients
with
contraindications
to
heparin
therapy
,
such
as
heparin-induced
thrombocytopenia
.
Few
data
exist
regarding
the
use
of
DTIs
in
pediatric
patients
.
To
characterize
the
use
of
DTIs
in
pediatric
patients
,
including
monitoring
strategies
and
bleeding
complications
.
A
retrospective
descriptive
study
was
designed
and
the
Pediatric
Health
Information
System
database
was
queried
from
2004
to
2011
for
pediatric
patients
receiving
a
parenteral
DTI
.
Patient
demographic
and
hospital
data
,
mortality
,
disease
state
,
and
procedure
information
(
from
International
Classification
of
Diseases
,
Ninth
Revision
codes
)
were
collected
from
the
query
.
DTI
monitoring
information
was
also
collected
.
Patients
were
divided
into
2
time
periods
(
2004
-
2007
,
2008
-
2011
)
to
evaluate
trends
.
Two
hundred
eight
patients
met
study
criteria
(
50
.
9
%
male
,
64
.
4
%
white
)
,
and
children
(
2
-
12
years
of
age
)
represented
34
.
6
%
of
the
population
.
Congenital
heart
disease
was
present
in
43
.
8
%
and
cardiovascular
surgical
procedure
occurred
in
28
.
4
%
.
Argatroban
was
most
commonly
used
(
73
.
1
%
)
and
bivalirudin
use
increased
(
P
<
.
001
)
.
Bleeding
complications
were
present
in
37
.
9
%
of
patients
and
mortality
was
19
.
7
%
.
Bleeding
complications
were
associated
with
lepirudin
(
62
.
5
%
)
and
argatroban
(
41
.
7
%
)
more
often
as
compared
with
bivalirudin
(
18
.
8
%
)
(
P
<
.
001
)
.
Activated
partial
thromboplastin
time
and
prothrombin
time
were
used
more
often
in
patients
receiving
argatroban
and
lepirudin
in
comparison
with
bivalirudin
,
and
thrombin
time
was
used
more
often
in
patients
receiving
lepirudin
(
P
<
.
001
)
.
Activated
clotting
time
use
increased
over
time
(
5
.
1
%
versus
17
.
5
%
,
P
=
.
02
)
.
Pediatric
use
of
DTIs
is
infrequent
and
occurs
in
patients
with
high
morbidity
and
mortality
.
Diseases
Validation
Diseases presenting
"prothrombin time were used more often in patients receiving argatroban and lepirudin in comparison with bivalirudin"
symptom
heparin-induced thrombocytopenia
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